Provider Demographics
NPI:1417275819
Name:GUPTA, SANJIV
Entity type:Individual
Prefix:
First Name:SANJIV
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 SHARON PARK DR
Mailing Address - Street 2:UNIT 210
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-6938
Mailing Address - Country:US
Mailing Address - Phone:650-823-7265
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DRIVE
Practice Address - Street 2:ROOM H3589
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5640
Practice Address - Country:US
Practice Address - Phone:650-498-4899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112178207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology